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Oral Pathology > Chapter 12 > Flashcards

Chapter 12 Flashcards

1
Q
A

Fibroma

* Most common “tumor” of the oral cavity *

Hyperplasia of FIBROUS connective tissue in response to local irriant or trauma

Most common location –> BUCCAL mucosa along the bite ling

Asymptomatic, sessile, smooth-surfaced nodule

Similar to mucosal coloring

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2
Q

Most common location for a fibroma?

A

Buccal mucosa along the occlusal plane (bite line)

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3
Q

Treatment for Fibroma?

A

Surgical excision

MUST submit to biopsy

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4
Q
A

Retrocuspid Papilla

“Giant Cell Fibroma”

Fibrous tumor with distinctive features - not associated with chronic irritation

YOUNGER patients

Gingiva - lingual to mandibular cuspids

BILATERAL

Normal anatomic variation – regresses with age

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5
Q

Treatment for Retrocuspid papilla

A

NO biopsy is needed

Can leave alone – may regress with age

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6
Q

Inflammatory Fibrous Hyperplasia (IFH)

A

Tumor like hyperplasia – FIBROUS connective tissue

* Tumor –> fibrous CT and inflammatory cells*

Epulis Fissuratum

Predominately found on GINGIVA

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7
Q
A

Epulis Fissuratum

“Inflammatory Fibroous Hyperplasia”

Associated with flange on ill fitting DENTURES

Facial aspect of alveolar ridge

Treatment –> Surgical removal and remake denture

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8
Q
A

Inflammatory Papillary Hyperplasia (IPH)

Reactive tissue growth that develops under a denture

Due to:

Ill fitting denture

Poor denture hygiene

Wearing a denture 24 hours a day (20% of denture patients)

Asymptomatic

Erythematous tissue

Pebbly or papillary surface

May also have a CANDIDAL infection

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9
Q

Treatment of Inflammatory Papillary Hyperplasia

A

Relieve tissue of dentures

Surgical extraction

Anti-fungals

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10
Q

Fibrous Histiocytoma

A

Occurs mostly on SKIN –> DERMATOFIBROMA

Painless nodular mass

Treatment –> surgicl excisions

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11
Q

Oral Focal Mucinosis

A

Overproduction of hyaluronic acid by fibroblasts

YOUNG FEMALES

Most common location – gingiva

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12
Q

4 differential of lesions that occcur on GINGIVA

A

IFH - Inflammatory fibrous hyperplasia

Pyogenic granuloma

Peripheral Giant Cell Carcinoma

Peripheral Ossifying Fibroma

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13
Q
A

Pyogenic Granuloma

Reactive lesion to local irritant or trauma (poor oral hygiene)

RAPID growth

Predilection for GINGIVA

PREGNANT women (defer treatment)

Smooth lobulated mass - pedunculated

Ulcerated and lesion bleeds easily - hyperplasia of capillaries

Treatment –> Surgical excision

Should extend down to periosteum and adjacent teeth scaled

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14
Q
A

Peripheral Ossifying Fibroma (POF)

Occures eclusively –> on gingiva

**INCISOR CUSPID REGION **

Nodular mass - originating from dental papilla

Treatment — excision down to periosteum and scall teeth

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15
Q
A

Peripheral Giant Cell Granuloma (PGCG)

Occures exclusively on GINGIVA or edentulous alveolar ridge

May produce a “CUPPING” resorption of the underlying alveolar bone

Erythematous mass –> BLUE or PURPLE

Treatment – excision down to underlying bone

Histology –> GIANT CELLS

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16
Q
A

LIPOMA

Benigna tumor of fate

Most common MESENCHYMAL NEOPLASM

Soft, fluctuant

Smooth surfaced nodular mass

Yellow or mucosal colored

50% on BUCCAL MUCOSA

**FLOAT in FORMALIN**

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17
Q
A

Neuroma

Traumatic neuroma or palisaded encapsulated neuroma

Proliferation of neural tissue after injury

1/3 are painful

MENTAL FORAMEN

Treatment – surgical removal

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18
Q

Schwannoma

A

“Neurilemoma”

Benign neural neoplasm of schwann cell origin

Half of cases occur in Head and Neck

Slow growing

Encapsulated tumor

Association with a nerve trunk

Typically Asymptomatic

Most common location: Tongue

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19
Q

Histology of Schwannoma

A

Antoni A –> organized: streaming fasicles of spindle-shaped schwann cells. Surround eosinophilc areas known as Verocay bodies

Antoni B –> unorganized

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20
Q

Neurofibroma

A

Most common peripheral nerve neoplasms

Young adults

slow growing

Soft

Painless

Most common location: Skin, Tongue, buccal mucosa

Treatment –> surgical excision

** CHECK PATIENT FOR NEUROFIBROMATOSIS **

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21
Q

Neurofibromatosis Type I

A

Hereditary

Most common form of the 8 types

NF1 –> von Recklinghausen’s disease of the skin

Pathognomonic –> Plexiform variant of NF

2/3 of patients have a milde disease.

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22
Q

Plexiform Variant of Nuerofibroma

A

“Bag of worms”

Pathognomonic for Neurofibromatosis Type I

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23
Q

Neurofibromatosis Type I Diagnositc critera (6)

A

Six or more cafe au lait macules (coast of california - smooth borders)

2 or more Neurofibroma OR 1 plexiform Neurofibroma

Crowe’s Disease (axillary region)

Optic glioma

2 or more iris hamartomas (LISH NODULES)

Osseous lesion

First degree relative with NF1

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24
Q
A

Cafe au lait macule

“Coast of California” – smooth borders

Diagnostic criterea for Neurofibromatosis (six or more)

25
Q
A

Crowe’s Sign

** freckling in the axillary region **

Diagnostic sign of Neurofibromatosis

26
Q
A

Lisch nodules

Diagnostic for neurofibromatosis type I

27
Q
A

Recklinghausen’s Disease of the skin

Neurofibromatosis type I

28
Q

Oral Manifestations Neurofibromatosis Type I (3)

** 90% of patients **

A

Enlargement of the fungiform papilla

Intraoral neurofibromas

Enlargment of mandibular forament or canal

29
Q

Up to 5% have malignant peripheral nerve sheath tumors – Nuerofibromatosis Type I

A

.Malignant peripheral nerve sheath tumor

30
Q

Multiple Endocrine Neoplasia Type 2B

A

MEN 2B

System complex – involves many organs

_____________________________________________________

Pheochromocytoma –> adrenal gland tumors

Medullar carcinoma —> thyroid tumors

Mucosal neuromas –> multiple (usually only one) –FIRST SIGN!

_____________________________________________________

Marfanoid build – thin and elongated limbs

Narrow face with thick protuberant lips

Bilateral neuromas of commissural mucosa

Diagnosed by 18 - 25 Die around 21

31
Q

Phoechromocytoma

A

Adrenal gland tumors

Multiple endocrine neoplasia Type 2B

32
Q

Medullary Carcinoma

A

Thyroid Tumors

Multiple endocrine neoplasia, Type 2B

33
Q

Marfinoid build

Narrow face

Proturberant lips

Bilateral nuerofibromas in commisures

A

Multiple endocrine neoplasia type 2B

34
Q
A

Melanotic Neuroectodermal Tumor of infancy

Rare - pigmented tumor

Congenital - occur during 1st year

Anterior Maxilla

Diagnose using –> using urinary test. Detect Vanillylmandelic Acid (VMA)

Mostly benign

35
Q

Diagnostic test for Melanotic Neuroectodermal Tumor

A

Elevated urinary levels of Vanillylmandelic Acid (VMA)

36
Q
A

Granular Cell Tumor

Benign soft tissue neoplasm (be suspicious if biopsy indicates otherwise)

Most common site –> TONGUE (dorsal surface)

Appears yellow or mucosal colored

Asymptomatic nodule (deep tissue)

Exhibit Pseudoepitheliomatous Hyperplasia (PEH)

Positive S-100 immuno stain

Surgical excision

37
Q

Pseudoepitheliomatous hyperplasia (2 disease)

A

Blastomycosis

Granular cell tumor

38
Q
A

Congenital Epilus

**Alveolar Ridge of newborns**

Appears –> mucosal colored, smooth, polypoid mass

Location –> lateral incisor canine area

S-100 NEGATIVE

Surgical Excision

39
Q

Histologically similar except for S-100 results

* Granular Cell Tumor –> ?

* Congenital Epulis –> ?

A

Granular Tumor –> S-100 POSITIVE

Congenital Epulis –> S-100 NEGATIVE

41
Q
A

Hemangioma

Most common tumor of infancy

Most common location –> HEAD AND NECK

Types:

* Cavernous –> Typically blanches, DARK RED - PURPLE

* Capillary –> May not blanch, RED

42
Q

Sturge-Weber Angiomatosis

A

Rare NONHEREDITARY DEVELOPMENTAL condition

Port Wine Stain** – **NEVUS FLAMMEUS

(Dermal capillary vascular malformation)

Unilateral distribution along one or more segments of the trigeminal nerve.

May be associated with:
Convulsive disorder

Mental retardation

Contralateral hemiplagia

Intraoral involvement –> hypervascular changes in ipsilateral mucosa

(Lesions may hemorrhage)

43
Q
A

Nevus Flammeus

“port wine stain”

Associated with Sturge-Weber Angiomatosis – not all patients with a port wine stain have Sturge-Weber Angiomatosis

44
Q
A

Lymphangioma

Benign tumor of LYMPHATIC VESSELS

Types: Capillary, Cavernous, Cystic

Cavernous –> frequently found in the mouth

Cystic –> occur on the neck

Oral lymphangioma –> Frequently on the anterior two thirds of the TONGUE can cause **MACROGLOSSIA**

Looks like “frog eggs”

45
Q

Cystic Hygroma

A

Cystic lymphangioma

Often occur in the neck

46
Q

Lateral neck mass differential:

A

Dermoid Cyst

Epidermoid cyst

Cervical lymphoepithelial cyst

Thyroid duct cyst

Cystic hygroma (cystic lymphangioma)

47
Q

Leiomyoma

A

Benign tumors of smooth muscle

Cured by surgical excision

48
Q

Rhabdomyoma

A

Benign neoplasm of SKELETAL MUSCLE

Typically affects CARDIAC & Head and Neck

Head and Neck region –> Adult: pharynx and FOM Children: Predilection for face

Surgical Excision

49
Q

Soft Tissue Sarcomas

A

Rare in oral and maxillofacial region –> 1%

Fibrosarcomas (H&N)

Malignant fibrous histocytoma

Liposarcoma

Leiomyosarcoma (uterus, GI)

Angiosarcoma (scalp and forehead)

Malignant peripheral nerve sheath tumor (MPNST) – (benign: neurofibroma, schwannoma)

50
Q

Sarcoma –>

Carcinoma –>

A

Sarcoma –> cancer of MESNCHYMAL origin (rare in H&N)

Carcinoma –> cancer of EPITHELIAL origin

51
Q
A

Kaposi’s Sarcoma– HSV 8

Four clinical presentations: Classic, Endemic, Iatrogenic immunocomprimised, AIDS

Treatment: depends on type, stage, location

* radiation, surgery, and chemo*

52
Q

Classic Kaposi Sarcoma

A

Older men

Italina, Jewish, Slavic

Multiple, asymptomatic blue purple macules on lower extremities – may turn into nodules

Good prognosis: 90% survival

53
Q

Endemic Kaposi’s Sarcoma

A

Has 4 subtypes

Poor prognosis

54
Q

Iatrogenic Kaposi’s Sarcoma

A

Organ transplant recipients

55
Q

Rhabdomyosarcoma

A

Malignancy of SKELETAL muscle

Common in children –> 60% of soft tissue sarcomas

Large portion occur in the H&N–> Face and neck

Painless

Rapid growth

Infiltrative mass

Try all treatments: Sugery, chemo, radiation

56
Q

Metastases to the ORAL SOFT TISSUE

A

** LYMPHATICS**

Metastes to lower body are more likely blood-borne: would be found in the lungs

Found in:

2/3 –> Soft Tissue (50% gingiva, 25% tongue)

1/3 –> Bone

Lesions appears as nodular mass with hyperplastic growth

(most cases represent CARCINOMA rather than sarcoma)

Poor prognosis

57
Q

H&N mets in absence of lung mets:

A

Batson’s Plexus

Valvless vertebral venous plexus – might allow retrograde spread of tumor cells and bypass the lungs

58
Q

Batson’s Plexus

A

Valveless vertebral venous plexus – might allow retrograde spread of

59
Q

Neurofibromatosis type II

A

Bilateral schwannomas of auditory vestibular nerve

Symptoms:

Deafness, Dizzines, and Tinnitus

Mutation of tumor suppressor gene on chromosome 22

Oral Pathology (17 decks)

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